Death Of A Dream

Miscarriages: Isolation Often Compounds Grief

November 08, 1992|By JILL KEECH Daily Press

There is no tiny body to lay to rest, no soft lock of hair to hold as a keepsake. There is no need for a coffin or a grave side service. When a woman has a miscarriage, there is nothing tangible to mourn.

It's as if nothing ever happened.

So how does a couple, enchanted with the promise of new life, mourn a death that society doesn't see?

Elizabeth Thomas will make a quilt for the baby that lives now only in her memory. In late May, when she was 10 weeks pregnant, Thomas had a miscarriage.

"It is a mourning quilt," says Thomas, who resides in Williamsburg with her husband, Kirk Savage. "I feel like it's my personal memorial project. We really experienced the death of a dream."

All too often, a sense of isolation compounds the grief that couples like Thomas and Savage share.

"You want your loss to be acknowledged," Thomas says. "My friends write me letters like it never happened. I want them to say to me, `I know you must be so sad. I know this must be hard for you.' It would make me feel more like I existed in the world - my experience and my baby existed in the world."

Whether out of awkwardness or insensitivity, people gloss over miscarriage, despite the frequency with which it happens.

Miscarriage is an everyday occurrence - estimated to occur in 30 to 50 percent of all pregnancies, says Barry L. Gross, an obstetrician and gynecologist with offices in Newport News and Gloucester.

Years ago, he says 15 percent was the going estimate. Miscarriage traditionally has been underreported, a phenomenon less likely to happen with today's medical technology. Today a woman knows much earlier if she is pregnant. If she begins to bleed, she knows there is a threat of a miscarriage, not a late period.

Generally, when a woman miscarries, the fetus is expelled from her uterus, or womb, sometime before 20 weeks of pregnancy. When a baby dies before birth but after the 20th week of pregnancy, the term is stillbirth.

Sometimes, the fetus dies in the womb or is implanted outside the uterus and the doctor must remove it. In some cases, a woman's cervix, which is the mouth of the uterus, begins to open fairly early in the pregnancy and leads to a miscarriage.

Better imaging tests, like ultrasound, can tell whether the fetus is developing normally or has died. Blood tests can measure the presence or absence of the hormone the mother produces that provides the nutrient necessary for fetal development, says James M. Mullins III, Gross' partner.

"In the absence of the hormone, the fetus usually doesn't survive," Mullins says.

But in spite of diagnostic advancements, doctors still can't prevent the vast majority of miscarriages.

Every day, in communities everywhere, couples who've gotten the news of a positive pregnancy test can't wait to spread the word.

"I remember, before we lost the baby, we were so excited," says Thomas. "We told everybody. We told the garbage man."

There were plans to make.

"We talked about how we were going to rearrange the furniture," says Savage.

In May, the need for such discussions ended.

"I think most of the time, we don't know the exact reason why miscarriage occurs," Gross says. Some studies, however, estimate that 60 percent of early miscarriages are due to chromosomal abnormalities, he says.

"Maybe that's nature's way of taking care of the problem," says Kathy O'Connell, a Hampton obstetrician and gynecologist.

Many women today are deferring motherhood until careers are established and opting to have babies later in life. But as a woman ages, the quality of her ova, or eggs, may not be as good, and there is a higher incidence of miscarriage, says Charles C. Coddington, obstetrician and gynecologist at the Jones Institute for Reproductive Medicine at Eastern Virginia Medical School in Norfolk.

Many Americans wonder, too, if some features of today's high-tech workplace increase the risk of miscarriage. Do video display terminals pose a danger? Not according to a 1991 National Institute for Occupational Safety and Health study.

But a 1980-to-1989 Johns Hopkins University study, commissioned by IBM, has found a link between increased risk of miscarriage and two chemicals used by 30 female IBM workers in the manufacture of computer chips. Improvements have since been made to the work environment surveyed, says Les Szabo, IBM spokesman.

Regardless of the cause of a miscarriage, there is a high emotional price to pay.

That's no different from years ago, when miscarriage was a hush-hush affair, "or brushed off as no big deal," says Julie Rejzer, a Mary Immaculate Hospital labor-and-delivery nurse. But today, mental and maternal health experts urge men and women not to suffer in silence. They recommend that couples who've experienced miscarriage seek support - be it counseling or participation in a group with others who've been through the same experience.